Costs & Transparency Number One for 2020 on HCEG’s Top 10 List

By Clive Riddle, September 12, 2019

Once  September is upon us and Pumpkin Spice lattes invade your nearest Starbucks, Christmas decorations should be arriving any day at your nearest Costco, and its not too early to think about what  are the top issues we will be facing in the business of healthcare in new year ahead.

 The Healthcare Executive Group has been doing exactly that for the past decade, presenting their top 10 list of issues at this time for the next year, have announced that for 2020 “Costs & Transparency was voted as the #1 issue/challenge facing healthcare by over 100 C-Suite and director level executives in the industry.”

HCEG explains that “executives from payer, provider and technology partner organizations were presented with a list of over 25 topics. Initially compiled from webinars, roundtables and the 2019 Industry Pulse Survey, the list was augmented by in-depth discussions during the [HCEG Annual] Forum, where industry experts explored and expounded on a broad range of current priorities within their organizations.”

Ferris W. Taylor, HCEG Executive Director in a statement comments that “It shouldn’t be surprising that costs and transparency is at the top of the list along with the consumer experience and delivery system transformation. Data, analytics, technology and interoperability are still ongoing challenges and opportunities. At the same time, executives need to be cautious, as individual health, consumer access, privacy and security are on-going challenges that also need to remain as priorities.”

Here, verbatim is the 2020 HCEG Top 10 Challenges, Issues and Opportunities:

1. Costs & Transparency - Implementing strategies and tactics to address growth of medical and pharmaceutical costs and impacts to access and quality of care.

2. Consumer Experience - Understanding, addressing and assuring that all consumer interactions and outcomes are easy, convenient, timely, streamlined,  and cohesive so that health fits naturally into the “life flow” of every individual’s, family’s and community’s daily activities.

3. Delivery System Transformation - Operationalizing and scaling coordination and delivery system transformation of medical and non-medical services via partnerships and collaborations between healthcare and community-based organizations to overcome barriers including social determinants of health to effect better outcomes.

4. Data & Analytics -  Leveraging advanced analytics and new sources of disparate, non-standard, unstructured, highly variable data (history, labs, Rx, sensors, mHealth, IoT, Socioeconomic, geographic, genomic, demographic, lifestyle behaviors) to improve health outcomes, reduce administrative burdens and support transition from volume to value and facilitate individual/provider/payer effectiveness.

5. Interoperability / Consumer Data Access - Integrating and improving the exchange of member, payer, patient, provider data and workflows to bring value of aggregated data and systems (EHR’s, HIE’s, financial, admin and clinical data, etc) on a near real-time and cost-effective basis to all stakeholders equitably.

6. Holistic Individual Health - Identifying, addressing and improving the member/patient’s overall medical, lifestyle/behavioral, socioeconomic, cultural, financial, educational, geographic and environmental well-being for a frictionless and connected healthcare experience.

7. Next Generation Payment Models - Developing and integrating technical and operational infrastructure and programs for a more collaborative and equitable approach to manage costs, sharing risk and enhanced quality outcomes in the transition from volume to value. (bundled payment, episodes of care, shared savings, risk-sharing, etc).

8. Accessible Points of Care - Telehealth, mHealth, wearables, digital devices, retail clinics, home-based care, micro-hospitals; and acceptance of these and other initiatives moving care closer to home and office.

9. Healthcare Policy - Dealing with repeal/replace/modification of current healthcare policy, regulations, political uncertainty/antagonism and lack of a disciplined regulatory process. Medicare-for-All, single payer, Medicare/Medicaid buy-in, block grants, surprise billing, provider directories, association health plans, and short-term policies, FHIR standards, and other mandates.

10. Privacy / Security - Staying ahead of cybersecurity threats on the privacy of consumer and other healthcare information to enhance consumer trust in sharing data. Staying current with changing landscape of federal and state privacy laws.

Corresponding with Executive Director Ferris Taylor, I asked who the list has changed and evolved during the past five years. Ferris replied that “everything has changed in healthcare in the last 5 or so years and that is reflected in the changes in the HCEG Top 10. The Affordable Care Act was really the 'accessible care act' - upwards of 20 million more people now have insurance but affordability in terms of premiums and escalating deductibles have affected everyone. It shouldn't be surprising then that cost and transparency has gone to the top of the list. For 2020, the HCEG Top 10 relate much more to how central the consumer is for all stakeholders. Healthcare is finally coming into the 21st century with digital technology, holistic individual health and a focus on the consumer journey in everything we do." 


New Changes in Health Care Executive Pay

The Spring 2019 issue of Warren Salary Surveys is published and there are some interesting findings highlighted here.


Warren is the oldest and largest survey of its kind reporting 600 positions in the health care industry. Large and small health plans, health systems and ACOs are reporting their data every 6 months and the data includes salary, bonus by region and by size and type of plan.


This week saw a report of a large health system in the southwest began to move bonus payments in line with patient engagement. By using HCAPS score improvement as well as patient complaint resolution and satisfaction scoring to create a base formula for bonus pay, the health system is moving towards a more patient centric incentive system.


Signaling further changes in the health care compensation programs offered by Accountable Care Organizations and Health Maintenance Organizations, Warren is observing an increase in compensation for positions such as financial analysts representing a 3.32% increase over 2018 to $68,859 and Underwriters moving to $66,749 as an average reported nationally by over 160 plans over the past year (Collected in spring 2019).


VP of Planning and Development saw a large jump of 5% to $243,181.00 over last year, perhaps revealing more focus on new markets and new products. In the medical management departments, there was an increase in pharmacy service coordinator to $52,457, underscoring for many health plans the need to better manage pharmacy costs especially for Medicare Advantage patients.


The biggest gain was in the position of Clinical Informaticist: a 13% gain to a salary averaging $105,778. These people are very hard to find and several organizations have started to create an internal training program to move some of their health information specialists into affiliated support roles to learn the clinical informatics discipline and support the lead informatics person.


Finally, the newer lead executive positions in Accountable Care Organizations CEO show an average salary of $269,575 with a range of $211,911 in the mountain states to $356,888 in the northeast. The majority of the ACOs reporting were not-for-profit with an average of $280,953 salary. At this point few bonuses have been calculated for the ACO chief executive, but Warren sees the above formula of measuring patient engagement improvements to be a very new but a meaningful way for ACO Boards of Directors and managers to consider these types of incentives to attract and retain talented ACO executives who continue to be elusive in the marketplace.


Further information can be obtained at:


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: 

They Got Estimates Before Surgery — And A Bill After That Was 50% More

Before scheduling his hernia surgery, Wolfgang Balzer called the hospital, the surgeon and the anesthesiologist to get estimates for how much the procedure would cost. But when his bill came, the estimates he had obtained were wildly off.

Kaiser Health News

Friday, August 30, 2019

Health insurers slam CMS proposal to alter Medicare Advantage audits

Health insurers and their industry trade groups this week urged the federal government to scrap proposed changes to the way it audits Medicare Advantage plans, warning the changes could result in higher costs and reduced benefits for seniors.

Modern Healthcare

Thursday, August 29, 2019

Medicare Part D paid millions for drugs already covered by Part A hospice benefits

Despite a previous warning, the Center for Medicare and Medicaid Services failed to take steps to ensure the Medicare Part D program does not also pay for medicines that should be covered under the Medicare Part A hospice benefit, resulting in an estimated $161 million in duplicate payments in 2016, according to a new federal government analysis.

Stat News

Thursday, August 29, 2019

Administration ends protection for migrant medical care

The Trump administration has eliminated a protection that lets immigrants remain in the country and avoid deportation while they or their relatives receive life-saving medical treatments or endure other hardships, immigration officials said in letters issued to families this month.

AP News

Monday, August 26, 2019

Judge Cites Opioid ‘Menace,’ Awards Oklahoma $572M In Landmark Case

An Oklahoma judge has ruled that drugmaker Johnson & Johnson helped ignite the state’s opioid crisis by deceptively marketing painkillers and must pay $572 million to the state.

Kaiser Health News

Monday, August 26, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.



Key Consumer Touchpoints: Patient Bills and Patient Reviews

by Clive Riddle, August 23, 2019

Patient bills and patient reviews and two consumer touchpoints with significant business impact for providers. Two papers have just been released with survey results on these topics.

OODA Health in partnership with HIMSS has just released a 7-page report: Why Patient Payments are a System Issue, that examines “how consumer healthcare payment dysfunction affects all healthcare stakeholders, creating unforeseen system-wide issues and interfering with patient care. The study surveyed executives from U.S. hospitals and health systems, health insurers, payers and health plan administrators.”

Their survey found: 

  • Two-thirds of clinicians indicated that dealing with patient collections takes time away from patient care
  • Providers say 44% of patients are frequently distracted by bills and payment concerns, resulting in a lower level of compliance and adherence to medical plans
  • 67% of providers use patient collections to justify rate increases during payer negotiations
  • 85% of payers report that member satisfaction drives benefit design, at least to a moderate extent
  • 63% of payers report they want greater insight into how plan complexity is experienced by the member
  • 4% of payers indicated that having actual consumer payment data would improve their models

Meanwhile PatientPop has just released a 17-page white paper, their second annual study: Healthcare Providers Survey Report: Online Reputation Management,  in which they surveyed 233 healthcare providers nationwide about their online reputation management experiences to learn more and identify trends. PatientPop found that: 

  • 47.6% of healthcare providers say they’re not sure how to positively affect their reputation. 
  • 76.1% of healthcare providers worry about receiving negative reviews from patients; 41% are very or extremely concerned. 
  • 89.9% of healthcare providers have seen reviews of their practices online. 
  • More than half of healthcare providers say they have seen reviews of their practice on Google and Yelp. 
  • 64.5% of healthcare providers have visiting patients who say they’ve read a review of their practice. 
  • 52.2% of practices spend 10+ hours a week on administrative tasks related to patient communication. Of those, 34.7% spend 30+ hours a week.



Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: 

$16B veterans' health project hits major snag

Veterans Affairs Secretary Robert Wilkie insisted last week that the Trump administration is "on track" with a $16 billion project to connect medical records for the military and vets.


Friday, August 23, 2019 

Dialysis Industry Spends Big To Protect Profits

The dialysis industry spent about $2.5 million in California on lobbying and campaign contributions in the first half of this year in its ongoing battle to thwart regulation, according to a California Healthline analysis of campaign finance reports filed with the state.

Kaiser Health News

Friday, August 23, 2019 

Opioid Treatment Is Used Vastly More in States That Expanded Medicaid

States that expanded Medicaid under the Affordable Care Act have seen a much bigger increase in prescriptions for a medication that treats opioid addiction than states that chose not to expand the program, a new study has found.

NY Times

Thursday, August 22, 2019 

Exclusive: Cigna seeks sale of group benefits insurance business - sources

U.S. health insurer Cigna Corp is exploring a sale of its group benefits insurance business, which could be valued at as much as $6 billion, four people familiar with the matter said on Tuesday.


Wednesday, August 21, 2019 

The Collapse Of A Hospital Empire — And Towns Left In The Wreckage

The money was so good in the beginning, and it seemed it might gush forever, right through tiny country hospitals in Missouri, Oklahoma, Tennessee and into the coffers of companies controlled by Jorge A. Perez, his family and business partners.

Kaiser Health News

Tuesday, August 20, 2019 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.